Samizdata quote of the day

It is officially calculated that, between 2005 and 2009, up to 1,200 patients at Stafford Hospital died needlessly. Let us imagine that a comparable disaster occurred in any other institution or enterprise in this country. Suppose that hundreds of customers of the cold food counter at Sainsbury’s or Tesco died of food poisoning. Suppose that, at an army barracks, large comprehensive, steelworks, bank, hotel, university campus or holiday theme park, people died, and went on dying for years, at rates that hugely exceeded anything that could be attributed to the normal course of nature.

What would happen? In all cases – though more quickly in the private sector than in the public – the relevant management would be sacked. Indeed, the very idea of unnecessary deaths taking years to notice is almost inconceivable. Criminal charges would be brought. In many cases, the offending institution would close down.

But this is the National Health Service, and so we approach it with superstitious reverence, as if the fact that Stafford Hospital performed so many human sacrifices is so awe-inspiring that little can be done about it. For all its rhetoric of condemnation, this week’s report of the Mid Staffs inquiry by Robert Francis QC argues, in effect, that those in charge should stay in charge.

The success or extent of a socialist government can be measured as an inverse to the number of its citizens it has to kill in order to remain a going concern.

Institute a little socialism and you get a modest number of people dying while under government care in hospitals. Institute a lot of socialism and you get much larger numbers of people dying while under government care in camps.

My mother was in hospital briefly for exhaustion and dietary problems (later found to be colon cancer). In the time she was their the NHS hospital in Bradford nearly killed her with an MRSA infection.

It seems to me, that certainly for old people, the best way of staying alive and healthy is to do whatever it takes to stay out of NHS hospitals.

The NHS is a perfect example of everything that is wrong with this country.

Whilst the NHS, BBC and British politicians continue to push the line that the NHS is the best health service in the world, people will continue to die or be killed by the NHS (i.e. the Liverpool ‘care’ pathway)

Of course – this is the nature of modern culture (what Perry calls the “Metacontext”).

Failure in a non state undertaking is met by demands for more statism.

But failure in a state enterprise (for example the “NHS”) is NOT met by demands for less statism.

On contrary – nonexistent “cuts” will be blamed, and the demand for yet more government spending will be raised.

Indeed sometimes the statism of the culture goes beyond folly – into insanity.

For example, the 100% state owned railway system is called “private” – and any accident (caused perhaps by the unionised workforce?) is met by demands for “renationalisation” (as if the structure of “Network Rail” can be more than 100% government owned).

It does tend to lead me to the conlusion that, as Private Fraser would say “We Are Doomed”,

Billll:
“Institute a little socialism and you get a modest number of people dying while under government care in hospitals. Institute a lot of socialism and you get much larger numbers of people dying while under government care in camps.”

But by Parkinson’s Law, the amount of socialism increases as inexorably as the amount of entropy.

Color this American astonished to see a term like “Liverpool Care Pathway”. I’d bet such a term was deliberately chosen to obfuscate what it really means, much in the way that so many British government agencies have been given Newspeak-sounding names.

My experience in the workplace has led me to believe that competent workers tend to get the job done no matter how incompetent their managers are. They invent work-arounds in order to bypass stupid management decisions. I speak from the experience of working under a manager who was so stupid that he had difficulty counting up to four, yes really. The way to deal with his instructions was to ignore them because he forgot what he had said almost instantly. He often issued instructions completely at odds with what he had said ten minutes ago. Knowing all this I have real difficulty in coming to terms with how incompetent the managers at this hospital had to be, to even overide the general competence of their staff.

The Culture. It would seem there is a widespread belief that there is such a thing as “rational ignorance,” as a result of which it is not particularly rational for any potential voter to waste time studying up on political affairs, researching candidates’ histories and positions, and so forth; in fact voting itself may be a pointless activity for any particular individual.

Because, it is said, any given person’s probability of affecting the outcome of the vote is statistically tiny.

First, and most obvious, there is such a thing as the cumulative effect of tiny increments. That, of course, is in fact the way voting works; the very notion of the statistical probability of a given person’s vote’s determining the outcome is really not even applicable. There are any number of illustrative analogies. Suppose a large, but finite, number of chimpanzees–say, a zillion of them–throw identical-sized rocks into the Grand Canyon at the same time. Is it sensible to ask WHICH chimpanzee threw the rock that filled the Canyon? Is it “rational” for any given chimp to decide that probably his particular rock will not be the one that fills the Canyon? And that therefore, though filling the Canyon is the aim of the group effort, he shouldn’t bother doing it?

In short, it’s not because of ANY one, PARTICULAR person’s vote that X won the election. It’s because of the AGGREGATED EFFECT of the votes for and against X. And (assuming all the votes are counted accurately and are honestly reported), EVERY vote cast counts toward that aggregate effect.

Second, it’s true that all of us have only a finite amount of time at our disposal, and (probably) infinitely many ways in which we could spend each second of it. So we must prioritize, and it may well turn out to be, per our own circumstances and value system, better to spend time learning how to take the best possible care of the coming infant than to educate ourselves properly regarding political philosophy, the current situation, and the candidates. But that’s a question of the rational choice of priorities, and persons in different situations might choose differently–for instance, perhaps the pregnant lady has already chosen adoptive parents who will assume parentage of the newborn immediately she delivers.

But–this leads us to the third point, which is that each of us has to live with the consequences of the fact that X won. And this will often enough have an effect not only on our own lives even years hence, but also on the lives of the next generation, and the one after that, and ….

Finally, in general: while ignorance in any field may be necessary for any of a variety of reasons, it is rarely in and of itself rational–even knowing baseball statistics is of value to some. (There are a relatively few cases where willful blindness is helpful as a method of self-control; as for instance in an extreme emergency in which one is liable to panic, and so persuades oneself to believe that the situation will end well. In fact, even in non-panic situations where it’s nevertheless necessary not to become demoralized.)

“There is no such thing as useless knowledge.”

. . .

However, all of this impinges on the issue of whether a society is encouraged to maintain itself in a state of ignorance (that is, whether individuals are discouraged by their society, their culture, and their various leaders in their desire and attempts to learn all they can), and is encouraged to believe the educational theory making the rounds in the early 70’s, which was (and, if you believe in Rational Ignorance as a good excuse not to bother learning, still is) that “you don’t need to know, you just need to know how to Look It Up.”

One of the great gifts of political liberty is that it does not encourage ignorance….

Which brings us to the concept of Enlightened Self-interest, about which we Children of the Fifties were taught in high school. Enlightened Self-interest, as we were taught the concept, meant that one pursues knowledge in matters which seem likely to have a serious effect on the long-term course of one’s life; that one seeks what one, being educated, believes will be beneficial to one in the long term; that one understands that “sauce for the goose is sauce for the gander,” that one ought not to do unto others what one would not have them do unto one, that in forcing others to follow one’s own orders against their wills one has lost one’s own right of self-determination; and that while it might not be in one’s short-term self interest to give the neighbor one’s last cup of milk for her baby, it might very well be in one’s long-term self interest: partly because helping others does often feel good when it’s voluntary, and partly because one is either repaying a prior kindness from the neighbor or because one understands that a spirit of cooperation on some level or other tends to benefit oneself materially, in the long run.

That, by the way, is not precisely the way Wikipedia describes Enlightened Self-interest. But it’s jolly well what I mean by it and I think it’s pretty well what we learned in high school is the moral philosophy (as opposed to political or theological philosophy) which we as Americans inherited from our founders and their philosophical forebears, and which we should keep going as part of our legacy, as a moral policy that works in promoting both individual happiness and social harmony rather than discord (which generally does also make our individual lives more pleasant), and as the moral policy that embraces and encourages whatever inclination to virtue and goodness we may have achieved so far.

I assume that by “Fisher” you meant “Francis”? If so, now that you point it out I assume that there has been a sea change and all will now be utterly committed to the saving of lives–even putting those of humans above those of the polar bears who are not drowning for lack of sea ice.

Oddly enough it was indeed your comment that provoked my little lecture above. The more important point of nexus being your reference to Public Choice Theory–which initially struck me as suggesting a degree of disapproval, and against which I have a bias because though I really don’t know anything about it, I have the impression that “Public Choice” types also believe in “Rational Ignorance” on the part of voters actual or potential as actually being the (the) rational stance in general–which I say it is not, and certainly not on the grounds for which it is argued.

On second reading, I see that you really didn’t say any such thing: I may well have read it into your remark. So now I’m curious as to what your assessment of this wondrous Public Choice theory really is, if you’d care to say.

But the second junction point has to do with a culture where ignorance is considered acceptable–not because everyone is, of necessity, ignorant before or unless learning takes place, but because (if the truth were told) it provides excuses one can trot out to oneself and others for not bothering to learn. It’s true (I think) that most of us at times are genuinely ignorant about something we should or must do to avoid disaster–but the general “cultural” attitude that deliberate ignorance is rational/reasonable/acceptable in situations where we’ve contracted to see to the lives and well-being of all our charges is most certainly an unconscionable one for the NHS or any medical personnel to take.

Observations so far indicate that “culture” in any** grouping is formed by the objectives sought and means chosen by the members of that grouping.

Objectives sought are also matters of choice. As McCloskey has demonstrated those choices are not solely determined by “maximum utility,” nor by “maximum valuation” [Buchanan]. The same applies to the choices of means.

Those choices of objectives and means are generally constrained by the availability of resources and the environments in which made. When the environment for particular services (e.g., medical care) is transferred to the political context, the resulting decisions on choices have been demonstrated to follow the processes of “group decisions,” rather than those which occur in open or individual exchanges of services (contractual) and the resulting “culture” is political in nature, and the relationships within it correspond to those of political structures, principally bureaucracies.

A commonly observed feature of those cultures is that a major portion of the objectives of, and selection of means by, those operating inside them requires maintenance of a position in, and satisfaction of, a bureaucratic hierarchy, rather than solely or chiefly the functions of direct exchanges of services.

Since it probably would go way OT, going back to Papers on Non-Market Decision-Making (1966) , this might not be the place for discourse on (let alone assessment of) The Theory of Public Choice . Rather than evade discusion, I am open to it elsewhere (or perhaps here if it is raised as a thread).

What I tried to do was provide a limited link of the “culture” issue to a “gut” issue of Public Choice.

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